Article by
Barbados Today

Published on
December 18, 2012

My neighbour was regaling me with stories about old people who although long pass their prime were still very clever in her opinion.

One story was of an old lady who, while visiting the post office to cash her pension cheque, told the story of her son’s recent behaviour to those present.

As the story goes her son was “taking up everything that the ole girl put down in the house”. According to my neighbour, the elderly lady became so exasperated with his behaviour that she put some Epsom salts in the condensed milk as he would normally use it all, leaving nothing for her.

So this day in question true to form when she got up to make her “tea” she shook the condensed milk tin and found it empty. Not long afterwards she observed him (the son) taking several trips to the bathroom.

Another story was of a man who had just retired from his job of over 30 years. Having made several plans, including a cruise etcetera, found that his elderly mother’s health had deteriorated and his siblings had elected him the care giver since he now had the time.

At one time he became so exasperated with her for telling stories about him and his siblings to his “big up friends” of when they were boys that he went outside leaving her to sit in the house alone in the dark. When he re-entered the house the mother said to him, “You think that I am a cat? I cannot see in the dark!”

Now these stories, prima facie, may seem to be humorous but they have serious under tones of elder abuse. Added to these stories are the ones of individuals who take their elderly relatives to the hospital for health care and abandon them there while they (the relatives) continue to live in the home that is owned by this abandoned family member. The article this week is about some causes of elder abuse and neglect.

To begin with, let me provide a definition of elder abuse as provided by the World Health Organisation. In their article on Aging and Life Course, WHO defined elder abuse as “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person”.

Now when the ordinary person hears of elder abuse they may think of it only occurring in institutions like retirement homes or geriatric hospitals. They may also think that it means physical abuse where the caregiver either strikes or pushes the individual. However, elder abuse is much, much, more, and according to WHO also involves psychological abuse (where the individual is ridiculed or made fun of or is refused access to amenities, healthy food and clean clothing) sexual abuse (where the individual is made to undress in front of the caregiver and may even be molested sexually by members of the household) and financial abuse (where the person is deprived of their savings, income/pension or the benefits of their own home etc). Elder abuse has also been described as unintentional or intentional neglect, all of which underpin the circumstances in the opening vignette.

Moreover, the American Psychological Association has added another dimension to the definition provided by WHO and suggested that elder abuse is also a form of exploitation where relatives make use of the older person’s possessions for their own benefit while leaving the older individual devoid of their belongs. Some 20 years ago Kashani et al (1992) noted that elder abuse could range from over medicating the elderly person, withholding food and hygienic care to refusing to provide medicine or assistance.

Now you may think that elder abuse originates with strangers but au contraire, elder abuse is usually carried out by close relatives and friends in the home environment. Furthermore, according to Kashani et al there are several causes. These include resentment and stress, personality problems, a cycle of violence, the role theory and the family system theory to name a few.

Let us first examine resentment and stress. Kashani explained resentment and stress as caring for an elderly relative when the caregiver perceives that the responsibility is forced upon them by others. In other words there are cases where some siblings seek to avoid the responsibility of caring for their elderly relatives and may shift the responsibility on to one individual who may feel burdened by it.

In addition, other familial responsibilities and status or authority may prevent the caregiver from dedicating the time needed to provide the adequate care and time the elderly person needs. Having no one in the family who is willing to share the responsibility may create tension and the situation may become stressful.

Secondly, personality problems may occur where the caregiver may be severely troubled and may have a history of antisocial behaviour. In such a case, the elderly person may be exposed to severe risk of abuse. An example of this was reported in a news clip sometime ago, where authorities became suspicious of a signature on an elderly lady’s social security cheque.

On visiting the home they found her remains lying on a chair while her son carried on conversations with her as if she were alive. Another form of personality problems could be in the form of personality clashes between the caregiver and the elderly person who has grown accustomed to having things done in a particular way and cannot adjust to depending on another individual. Such persons may refuse to be taken the usual places (the post office, the bank etc) may attempt to go on their own and then become confused and/or lost.

There is also the theory that a cycle of violent behaviour within the home can often lead to elder abuse. For instance, Johnson (1979) argued that very often children who have been victims of abuse may themselves abuse their elderly parents in return.

Moreover, the role theory proposes the view that elderly parents expect their children to perform in the role of caregiver/parents but refuse to relinquish the authority to them. This behaviour creates psychological tension and unnecessary stress which often overwhelms the family member who is striving to cope with the situation.

Finally, the family system theory offers another explanation that often leads to elder abuse. This is where members of the family are in denial about the needs of their elderly parents. These individuals may be seeking to maintain some social status and may associate having to care for their elderly parent as a form of stigma to be hidden from others. So their behaviour remains shrouded in secrecy as all members of the family pretend that abuse in not occurring. What could compound the situation is where younger family member are unemployed and hence are dependent on the older person for support since the balance of power has now changed, the elderly person may be disadvantaged.

So how do we deal with this? We must all bear in mind that our society is an aging one and that sooner or later we will find ourselves having to cope with an elderly relative or we may be the elderly person. Firstly, we must be aware that elder abuse can be prevented or reduced through educating families and young adults about this problem. Knowing that they are not alone and that there are options available for support and care can mitigate against the problem of elder abuse.

One of the major problems identified in the literature is the financial inability of most families to provide nursing home care or home help services for older relatives. Therefore, government agencies and all stake holders must combine to develop the necessary laws and policies to support families in need of such services.

However, stringent screening must be made of such caregivers in order to prevent abusive treatment from developing.

Finally, the state/government must develop some form of protective services that would enable individuals to take recourse against abuse of elders through criminal and civil law. This could possibly prevent individuals from hiding elder abuse problems by pretending that they do not exist and do something about it before the person who is suffering the abuse is us.